Testosterone Deficiency Solutions for Women’s Hormonal Health

Find out how testosterone deficiency influences women’s hormonal health and what steps can be taken for improvement.

Abstract

For too long, the narrative surrounding women’s health has been one of passive acceptance, where symptoms like fatigue, depression, weight gain, and diminished libido are dismissed as inevitable consequences of aging. This post challenges that outdated perspective. As Dr. Alex Jimenez, I bring my extensive background in chiropractic, functional medicine, and advanced practice nursing to shed light on a critical, yet often overlooked, component of female vitality: testosterone. We will explore the latest evidence-based research from leading institutions, demonstrating that testosterone deficiency in women is a real and treatable medical condition, not a personal failing or a normal part of getting older. This article will deconstruct the complex physiology of testosterone production and its profound impact on a woman’s mood, cognitive function, metabolic health, bone density, and overall quality of life. We will differentiate between primary and secondary hypogonadism, providing a clear roadmap for proper diagnosis through specific lab testing. We will also explore the root causes of hormonal imbalances, from thyroid dysfunction and chronic stress to the metabolic impact of severe caloric restriction. This post serves as an educational journey, empowering you with the knowledge to reclaim your health. We will also discuss how our unique multidisciplinary practice in El Paso, Texas, integrates advanced chiropractic care, functional medicine, and medical oversight by our esteemed Medical Director, Dr. Maria Guadalupe Cardenas, MD, to provide a comprehensive, patient-centered approach to restoring hormonal balance and optimizing wellness.

Challenging the “Age Gracefully” Myth

In my years of clinical practice, I have had countless conversations with female patients who feel unheard and dismissed by the conventional medical system. They come to me with a familiar and disheartening story: they are struggling with persistent fatigue, a pervasive sense of low mood, unexplained weight gain despite their best efforts, a complete loss of interest in intimacy, and a general feeling that the vibrant person they once were is fading away.

What is the typical response they receive? Too often, it’s a prescription for an antidepressant and a pat on the back with the platitude to “age gracefully.” This approach is not only dismissive; it represents a fundamental misunderstanding of female physiology. It’s a profound disservice to millions of women who are suffering from a treatable hormone deficiency, not a primary psychiatric disorder. While depression is a serious condition that deserves appropriate care, misdiagnosing a physiological problem as a purely psychological one leaves the root cause unaddressed, condemning the patient to a cycle of unresolved symptoms and frustration.

It’s a lie that women are told that their hormones are complicated, that their symptoms are “normal,” and that fatigue, depression, weight gain, and lost libido are just part of getting older. My wife is 46 years old, and through a proactive, evidence-based approach to her health—one that I oversee as her doctor—she looks and functions with the vitality of someone in her mid-twenties. This isn’t magic; it’s science. The roadmap to achieving this is available to everyone, grounded in peer-reviewed research and a deep understanding of the body’s intricate systems. It’s time to dismantle the myth and replace it with empowering, evidence-based truth.

The Critical Role of Testosterone in Women’s Health

When we hear the word “testosterone,” the immediate association for most people is with men, muscle mass, and virility. While it is the primary male sex hormone, this narrow view completely overlooks its indispensable role in the female body. Women produce testosterone, and they always have. It is not an anomaly or a “male” hormone accidentally present in women; it is a vital cog in the machinery of female health, and its absence has devastating consequences.

Where Does Testosterone Come From in Women?

The production of testosterone in the female body is a carefully orchestrated process involving multiple organ systems. It’s not concentrated in a single location but is a collaborative effort:

• The Ovaries: These are the primary producers, responsible for approximately 50% of a woman’s circulating testosterone. This production is intricately linked to the menstrual cycle and the overall health of the reproductive system.
• The Adrenal Glands: Located atop the kidneys, these small but mighty glands are our stress-response hubs. They produce a variety of hormones, including cortisol, DHEA, and androstenedione, and produce about 25% of a woman’s testosterone.
• Peripheral Tissues: The remaining 25% is not produced directly but is synthesized through a process called peripheral conversion. This occurs when a precursor hormone, androstenedione (produced by both the ovaries and adrenal glands), is converted into testosterone within adipose (fat) tissue, muscle tissue, skin, and the liver.

This distributed production model highlights why a holistic, systems-based approach is crucial. A problem in the ovaries, the adrenal glands, or even in metabolic tissues like fat and muscle can disrupt testosterone levels and lead to significant health issues.

Why Do Women Need Testosterone? The Scientific Evidence

Testosterone is not just about libido, although that is certainly an important function. Its influence extends throughout the body, acting as a key regulator of numerous physiological processes. A significant 2021 publication in The Lancet Diabetes & Endocrinology solidified what many of us in functional and integrative medicine have observed for years. The researchers confirmed that testosterone deficiency in women is independently associated with a trio of debilitating conditions:

1. Decreased Mineral Bone Density: Testosterone directly stimulates osteoblasts, the cells responsible for building new bone. When levels are low, bone resorption (breakdown) can outpace bone formation, leading to osteopenia and eventually osteoporosis. This makes women more vulnerable to fractures, particularly as they age.
2. Sexual Dysfunction: This is often the most recognized symptom. Testosterone drives libido, or sexual desire, in both men and women. It also contributes to arousal, lubrication, and the ability to achieve orgasm. Low levels can lead to Hypoactive Sexual Desire Disorder (HSDD), causing significant personal and relational distress.
3. Impaired Quality of Life: This is a broad but critically important category. The study found a direct link between low testosterone and diminished well-being, encompassing mood, energy, and cognitive function.

It is crucial to understand the language used in this research. The term is “associated,” not simply “correlated.” A correlation might mean two things happen at the same time, but one doesn’t necessarily cause the other. In this clinical context, an association implies a much stronger, more direct relationship. If you have low testosterone, it is not a coincidence that you are also experiencing these symptoms; it is a direct physiological consequence.

Let’s break down the wide-ranging functions of testosterone in the female body even further:

• Lean Muscle Mass and Metabolism: Testosterone is an anabolic hormone, meaning it helps build tissues, particularly muscle. Maintaining healthy muscle mass is essential for a robust metabolic rate, as muscle is more metabolically active than fat. As testosterone declines, women find it harder to build or even maintain muscle and easier to gain adipose tissue, especially visceral fat around the abdomen, which is highly inflammatory and linked to metabolic syndrome.
• Cognitive Sharpness and Mood Stability: The brain is rich in androgen receptors. Testosterone has neuroprotective effects and supports cognitive functions like memory, spatial awareness, and focus. Low levels are linked to “brain fog,” difficulty concentrating, and mood instability. Many women presenting with symptoms of depression and anxiety actually have an underlying testosterone deficiency.
• Energy and Vitality: Testosterone contributes to the production of red blood cells (erythropoiesis), which are responsible for carrying oxygen throughout the body. Healthy levels support optimal oxygenation of tissues, leading to better energy, stamina, and a reduction in the pervasive fatigue so many women experience.
• Cardiovascular Health: Emerging research suggests testosterone benefits the cardiovascular system by promoting vasodilation (widening of blood vessels), which can help regulate blood pressure, and by favorably impacting cholesterol profiles.

Ignoring testosterone in women is akin to ignoring estrogen. Both are essential for health, and balance is key.

Our Integrative Approach at Injury Medical Clinic

At our practice in El Paso, we have built a unique clinical model designed to address these complex health issues from multiple angles. We recognize that no single discipline has all the answers, so we foster a deeply collaborative environment.

I, Dr. Alex Jimenez, bring my expertise as a Doctor of Chiropractic (DC) and an Advanced Practice Registered Nurse (APRN) with board certification as a Family Nurse Practitioner (FNP-BC). My additional certifications as a Certified Functional Medicine Practitioner (CFMP, IFMCP) and in Anti-aging and Regenerative Medicine (ATN) allow me to look at the body as an interconnected system, seeking the root cause of dysfunction rather than just managing symptoms. My focus on chiropractic care and rehabilitation addresses the critical neuro-musculoskeletal component of health, ensuring the body’s structure and function are optimized.

Working alongside me as our Medical Director and Collaborative Physician is Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected, board-certified Internist with over 40 years of clinical experience. Her NPI is #1164426749, and she is licensed in Texas under MD License #J2933. Her deep knowledge of internal medicine provides the essential medical oversight required for a safe, effective integrative practice. This multidisciplinary structure is common in leading-edge injury and wellness clinics, where a medical doctor’s expertise complements the work of chiropractors, functional medicine practitioners, and rehabilitation specialists.

Our team at Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) integrates the following services to create a truly comprehensive treatment plan:

• Medical Oversight (Dr. Cardenas): Cardenas provides the necessary medical direction, oversees prescription management (such as hormone replacement therapy), and ensures all treatments meet the highest standards of medical safety and efficacy.
• Functional Medicine (Dr. Jimenez): We use advanced diagnostic testing (hormone panels, nutritional assessments, gut health analyses) to identify the underlying biochemical and metabolic imbalances driving a patient’s symptoms. This is the “why” behind the illness.
• Integrative Chiropractic Care (Dr. Jimenez): The nervous system is the body’s master controller, and the spine is its protective armor. Misalignments (subluxations) and poor posture can interfere with nerve signaling between the brain and the body, including organs responsible for hormone production, such as the adrenal glands and ovaries. Chiropractic adjustments restore proper spinal mechanics, reduce neurological interference, and help downregulate the sympathetic (fight-or-flight) nervous system. This is particularly crucial for patients with HPA axis dysfunction, as it helps shift the body into a parasympathetic (rest-and-digest) state, which is necessary for healing and hormone balance.
• Rehabilitation and Personal Injury Care: For patients recovering from injuries, we combine chiropractic care with targeted physical rehabilitation to restore strength, mobility, and function, preventing chronic pain and long-term dysfunction that can contribute to systemic stress and hormonal disruption.

This collaborative model allows us to create personalized protocols that may include bioidentical hormone replacement therapy (BHRT) overseen by Dr. Cardenas, targeted nutritional supplementation and lifestyle changes guided by my functional medicine practice, and neuro-musculoskeletal optimization through my chiropractic care. It’s a 360-degree approach that addresses the whole person—biochemistry, structure, and lifestyle—for lasting results.

Understanding the “Why”: Primary vs. Secondary Hypogonadism

When a woman is diagnosed with low testosterone, a condition known as hypogonadism, it’s not enough to write a prescription. We must understand why the levels are low. Throwing exogenous (external) testosterone at the problem without identifying the root cause is like patching a leaking roof without fixing the hole. The term “hypogonadism” is often used carelessly, but it has two very distinct forms with completely different implications for treatment.

If you have low testosterone, it falls into one of two categories:

1. Primary Hypogonadism: The Factory is Broken

Primary hypogonadism refers to a problem originating directly in the gonads—in women, the ovaries. In this scenario, the ovaries have lost their ability to produce hormones, including testosterone and estrogen. Think of it like a car factory with a broken assembly line. The main office (the brain) can send all the production orders it wants, but if the machinery on the factory floor is non-functional, no cars will be built.

The Physiology:

The hypothalamus in the brain releases Gonadotropin-Releasing Hormone (GnRH), which signals the pituitary gland to release two key messenger hormones: Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). These hormones travel through the bloodstream to the ovaries and tell them to produce estrogen, progesterone, and testosterone.

In primary hypogonadism, the brain is working perfectly. In fact, it’s working overtime. The pituitary gland senses the low hormone levels in the blood and screams for more production by pumping out very high levels of LH and FSH. However, because the ovaries (the factory) are damaged or non-responsive, they cannot answer the call.

Lab Results in Primary Hypogonadism:

• LH and FSH: Sky-high
• Testosterone (and Estradiol): Rock-bottom

Common Causes of Primary Hypogonadism:

• Menopause: The most common cause. It represents the natural cessation of ovarian function.
• Surgical Menopause: Removal of the ovaries (oophorectomy) instantly stops their hormone production.
• Premature Ovarian Insufficiency (POI): Also known as premature ovarian failure, this is when the ovaries stop functioning before the age of 40.
• Oophoritis: Inflammation of the ovaries, often due to autoimmune disease or infection, which can damage their function.
• Genetic Conditions: Such as Turner syndrome.
• Damage from Chemotherapy or Radiation: These treatments can be toxic to ovarian tissue.

The Treatment Solution:

In cases of primary hypogonadism, the receiver is cooked. The signal from the brain is fine, but the ovaries cannot respond. There is no way to “fix” the broken factory. Therefore, the only effective solution is to provide the body with the hormones it can no longer make. This is achieved through:

• Exogenous Hormone Replacement Therapy (HRT): This involves replacing both estrogen and testosterone using bioidentical hormones, which are molecularly identical to those the body naturally produces.
• Supportive Cofactors and Peptides: We also use targeted nutrients (like B vitamins, zinc, and magnesium) that are essential for hormone metabolism, along with specific peptides that can help improve cellular sensitivity and overall systemic function.

2. Secondary Hypogonadism: An Upstream Problem

Secondary hypogonadism is a completely different beast. Here, the ovaries are perfectly healthy and capable of producing hormones. The factory is in pristine condition. The problem lies upstream, in the control center—the hypothalamus or the pituitary gland. The signal to produce hormones is either weak or absent altogether.

The Physiology:

In this case, the hypothalamic-pituitary-ovarian (HPO) axis is suppressed. The hypothalamus isn’t releasing enough GnRH, or the pituitary isn’t responding properly. This results in insufficient LH and FSH production. Without these crucial messenger hormones, the perfectly functional ovaries never receive the order to start production. They sit idle, waiting for a call that never comes.

Lab Results in Secondary Hypogonadism:

• LH and FSH: Low or inappropriately “normal” (meaning they are not elevated despite low sex hormones)
• Testosterone (and Estradiol): In the cellar

The Critical Question:

With secondary hypogonadism, the most important question is WHY? Why has management gone offline? Simply giving exogenous testosterone without investigating the cause is a grave clinical error. It might temporarily alleviate symptoms, but the underlying driver of the dysfunction will remain, potentially causing other health problems down the line. It’s treating a symptom, not the disease. You might feel a little better for a while, but you’ll still feel like crap overall because the root issue is festering.

Investigating the Root Causes of Secondary Hypogonadism

This is where a functional medicine approach becomes indispensable. We must play detective and uncover what is causing the suppression of the HPO axis. Here are the most common culprits I see in my clinical practice:

1. Thyroid Dysfunction: The Master Regulator

Before looking at anything else, you must check thyroid function. The thyroid gland is the master regulator of metabolism and profoundly influences every cell and system in the body, including the reproductive axis. A common scenario we see is the impact of elevated Sex Hormone-Binding Globulin (SHBG).

• The Role of SHBG: SHBG is a protein produced primarily in the liver. Its job is to bind to sex hormones—testosterone, DHT, and estrogen—and transport them through the bloodstream. Think of SHBG as a “hormone taxi.”
• Free vs. Total Testosterone: When testosterone is bound to SHBG (or albumin, another binding protein), it is biologically inactive. It’s essentially “handcuffed” and cannot interact with cell receptors. Only free testosterone—the small fraction that is unbound—can exert its physiological effects. This is the testosterone that matters for your muscles, brain, bones, and libido.
• The Thyroid Connection: Hypothyroidism (an underactive thyroid) or even subclinical hypothyroidism can lead to changes in hormone metabolism. Furthermore, elevated Thyroid-Stimulating Hormone (TSH), a sign the thyroid is struggling, can indirectly influence SHBG. More directly, excess thyroid hormone (hyperthyroidism or over-medication with thyroid hormone) is known to crank up the liver’s production of SHBG.
• The SHBG Trap: When SHBG levels are excessively high, it acts like a sponge, soaking up all the available testosterone. You could have a lab report showing a “normal” total testosterone level, but if your SHBG is through the roof, your free testosterone could be virtually zero. This is a common trap. The doctor glances at the total T, says it’s fine, and misses the real problem. The patient is left with all the symptoms of low testosterone because their body can’t use the hormone it has. SHBG is hoarding it all.

2. Chronic Stress and HPA Axis Dysfunction: The Pregnenolone Steal

Your body’s primary directive is survival. The hypothalamic-pituitary-adrenal (HPA) axis is the hardware for your stress response system. When you are under chronic stress—be it emotional, physical, inflammatory, or psychological—the adrenal glands are commanded to produce the stress hormone cortisol.

The problem is that cortisol and your sex hormones share a common biochemical origin. The production pathway for all steroid hormones begins with cholesterol, which is converted to a master hormone called pregnenolone. From pregnenolone, the pathway can branch in two primary directions:

1. To Progesterone -> Cortisol (the survival pathway)
2. To DHEA -> Testosterone and Estrogen (the vitality and reproduction pathway)

This is where a phenomenon known as pregnenolone steal (or cortisol shunt) comes into play. When you are chronically stressed, the body perceives a constant state of emergency. Survival takes precedence over everything else—including reproduction, metabolism, and long-term vitality. In this state, the adrenal glands prioritize cortisol production above all else. The enzymatic machinery shunts the available pregnenolone precursor down the cortisol pathway, effectively “stealing” it from the pathway that leads to DHEA and, subsequently, testosterone.

The Consequences:

• Low DHEA and Testosterone: Your sex hormone production plummets because the raw materials are being diverted.
• Elevated Cortisol: Chronically high cortisol is catabolic (it breaks down tissues like muscle and bone), causes insulin resistance, promotes belly fat storage, and suppresses the immune system.

You cannot supplement your way out of a cortisol problem. You can’t take a peptide or drink a magic tea to fix this. The only solution is to drop the HPA load. This involves actively managing stress through techniques like mindfulness, meditation, breathwork, gentle exercise, adequate sleep, and addressing the root sources of stress in your life. This is where integrative chiropractic care can be profoundly beneficial. By calming the nervous system and reducing sympathetic overload, chiropractic adjustments help shift the body out of a constant “fight-or-flight” state, thereby reducing the demand for cortisol and allowing the hormone pathways to rebalance.

3. Severe Caloric Deficit and Energy Scarcity: The Starvation Signal

This is a cause I am seeing with increasing frequency in my practice, especially with the widespread use of GLP-1 agonists (like semaglutide and tirzepatide) for weight loss. While these medications can be powerful tools, they can also lead to significant appetite suppression, sometimes resulting in a severe and prolonged caloric deficit.

The human body is exquisitely adapted for survival. The hypothalamus, the brain’s master regulator, constantly monitors the body’s energy status. If it detects energy scarcity or starvation, it initiates a series of protective shutdowns to conserve resources. Reproduction and high-performance functions are metabolically expensive. From a biological perspective, investing energy in building muscle or supporting a potential pregnancy during a famine is a terrible survival strategy.

The Physiological Shutdown:

• Suppression of GnRH: In response to a perceived energy crisis (from extreme dieting, over-exercising, or the effects of certain medications), the hypothalamus shuts down the pulsatile release of GnRH.
• Cascade Failure: Without the GnRH signal, the pituitary gland stops producing LH and FSH. Without LH and FSH, the ovaries stop producing estrogen and testosterone. The entire HPO axis goes dark.

This condition is known as hypothalamic amenorrhea in its most severe form, but even less extreme energy deficits can cause significant suppression of the HPO axis, leading to secondary hypogonadism.

The message is clear: Biology will never invest in reproduction or performance in a starvation state. Ever. You have to fix the energy issue first. This means ensuring adequate caloric intake, focusing on nutrient-dense whole foods to signal to the hypothalamus that the body is safe, nourished, and has enough energy to support all its vital functions.

The Essential Lab Panel: Your Diagnostic Toolkit

You cannot guess; you must test. To properly diagnose the cause of your symptoms and differentiate between primary and secondary hypogonadism, a comprehensive lab panel is non-negotiable. Asking your doctor for just “total testosterone” is not enough.

Here is the bare minimum list of labs you need to get a clear picture of what is happening with your hormones. I will list these in my stories for you to reference and take to your doctor, so you can start the process of fixing all of this.

• Total Testosterone: This measures the total amount of testosterone in your blood, both bound and free. It provides a general overview but is insufficient on its own.
• Free Testosterone: This is the most important marker. It measures the unbound, biologically active testosterone that your body can actually use. This number correlates most closely with symptoms.
• Sex Hormone-Binding Globulin (SHBG): Essential for interpreting your total and free testosterone levels. High SHBG can render your testosterone useless.
• Luteinizing Hormone (LH) & Follicle-Stimulating Hormone (FSH): These pituitary hormones are critical for differentiating between primary (high LH/FSH) and secondary (low or normal LH/FSH) hypogonadism. They must be interpreted in the context of your testosterone and estradiol levels.
• Prolactin: This pituitary hormone can suppress the HPO axis when elevated. High prolactin can be caused by stress, certain medications, or a benign pituitary tumor (prolactinoma) and must be ruled out as a cause of secondary hypogonadism.
• Comprehensive Thyroid Panel: Do not settle for just a TSH. You need a full panel to assess thyroid function properly:

• • TSH (Thyroid-Stimulating Hormone)
  • Free T4 (Thyroxine)
  • Free T3 (Triiodothyronine)
  • Reverse T3 (rT3)
  • Thyroid Antibodies (TPO and TG) to screen for autoimmune thyroid disease (Hashimoto’s).

• DHEA-S (Dehydroepiandrosterone Sulfate): This is an adrenal hormone that is a precursor to testosterone. Low levels can indicate adrenal insufficiency or pregnenolone steal.
• Estradiol (E2): The primary form of estrogen. Assess this alongside testosterone to understand overall hormonal balance.
• Complete Metabolic Panel (CMP) & Complete Blood Count (CBC): To assess liver and kidney function, electrolytes, and check for anemia.
• Fasting Insulin and Glucose: To assess for insulin resistance, which is deeply intertwined with hormone balance.

Armed with this data, a skilled practitioner can connect the dots between your symptoms and your biochemistry, develop an accurate diagnosis, and create a targeted, personalized treatment plan that addresses the root cause of your suffering. You don’t have to accept feeling less than your best. The information you need is in the research, and the tools are available. It’s time to take back control of your health.

References

• Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Lumsden, M. A., … & Stuenkel, C. A. (2019). Global consensus position statement on the use of testosterone therapy for women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660-4666. academic.oup.com/jcem/article/104/10/4660/5556132
• Islam, R. M., Bell, R. J., Green, R., Page, M. J., & Davis, S. R. (2019). Safety of testosterone therapy in women: a systematic review and meta-analysis of randomized controlled trials. The Lancet Diabetes & Endocrinology, 7(9), 754-766. www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30189-5/fulltext
• Vegunta, S., Kling, J. M., & Kapoor, E. (2020). Androgen therapy in women. Journal of Women’s Health, 29(1), 57-64. www.liebertpub.com/doi/abs/10.1089/jwh.2018.7494
• Meczekalski, B., Katulski, K., Czyzyk, A., Podfigurna-Stopa, A., & Maciejewska-Jeske, M. (2014). Functional hypothalamic amenorrhea and its influence on women’s health. Journal of Endocrinological Investigation, 37(11), 1049-1056. link.springer.com/article/10.1007/s40618-014-0169-3
• Stepien, T., & Kujawska-Luczak, M. (2021). The role of stress and HPA axis in the pathogenesis of female infertility. Neuroendocrinology Letters, 42(3), 173-181.

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